6 Rationale for Standard IC : In 2010, the Department of Health and Human Services (HHS) issued the HHS Action Plan to Prevent Healthcare-Associated Infections: Influenza Vaccination of Healthcare Personnel. This draft action plan states: Influenza transmission to patients by healthcare personnel (HCP) is well documented. HCP can acquire and transmit influenza from patients or transmit influenza to patients and other staff. Vaccination remains the single most effective preventive measure available against influenza and can prevent many illnesses, deaths, and losses in productivity. Despite the documented benefits of HCP influenza vaccination on patient outcomes, HCP absenteeism, and on reducing influenza infection among staff, vaccination coverage among HCP has remained well below the national 2010 health objective of 60%. 1 6

8 Joint Commission Actions: Revised Standard IC for critical access hospitals, hospitals, and long term care. Strengthened the requirements Aligned the requirements with the HHS Action Plan Conducted a field review for all accreditation programs from April 5, 2011 through May 17, Board of Commissioners approved Standard IC on September 21,

12 Payment for the influenza vaccination: The Joint Commission does not require accredited organizations to pay for the influenza vaccination for licensed independent practitioners and staff. 12

13 Introduction to Standard IC Influenza Vaccination for Licensed Independent Practitioners and Staff and The Elements of Performance (EP) 13

14 The goal of Standard IC is for organizations to: Establish an influenza vaccination program for staff and licensed independent practitioners. Set incremental goals for meeting the 90% target in Measure and improve influenza vaccination rates for staff and licensed independent practitioners. 14

15 The requirements for revised Standard IC are comparable across accreditation programs. However, The language can vary by accreditation program/setting. When an organization is accredited under more than one accreditation program, it is important that Standard IC be reviewed for each program. 15

16 Standard IC : Standard IC Standard: The organization offers vaccination against influenza to licensed independent practitioners and staff. Note: This standard is applicable to staff and licensed independent practitioners only when care, treatment, or services are provided on-site. When care, treatment, or services are provided off-site, such as with telemedicine or telephone consultation, this standard is not applicable to offsite staff and licensed independent practitioners. 16

17 Element of Performance (EP) 1: The organization establishes an annual influenza vaccination program that is offered to licensed independent practitioners and staff. No documentation required Scoring: A (exists or does not exist) Implementation: July 1,

18 EP 2: The organization educates licensed independent practitioners and staff about, at a minimum, the influenza vaccine; non-vaccine control and prevention measures; and the diagnosis, transmission, and impact of influenza. (See also HR , EP 4) No documentation required Scoring: C (frequency based scoring) Implementation: July 1,

20 EP 3: No documentation required Scoring: A (exists or does not exist) Implementation: July 1,

21 EP 4: Standard IC The organization includes in its infection control plan the goal of improving influenza vaccination rates. (For more information, refer to Standard IC ) Documentation required Scoring: A (exists or does not exist) Implementation: July 1,

22 EP 5: The organization sets incremental influenza vaccination goals, consistent with achieving the 90% rate established in the national influenza initiatives for Note: The U.S. Department of Health and Human Services' Action Plan to Prevent Healthcare- Associated Infections is located at: 22

23 EP 5: Documentation required Scoring: A (exists or does not exist) Implementation: July 1,

24 EP 5: Examples of meeting the intent and not meeting the intent of Standard IC : Meeting the intent: Organization A has a current influenza vaccination rate of 50% and sets the following goals: 2012: 60% 2014: 75% 2016: 85% Not meeting the intent: Organization B has a current influenza vaccination rate of 50% and sets the following goals: 2012: 52% 2014: 54% 2016: 55% 24

25 EP 6: Standard IC The organization has a written description of the methodology used to determine influenza vaccination rates. (See IC , EP 1) Note: The National Quality Forum (NQF) Measure Submission and Evaluation Worksheet 5.0 provides recommendations for the numerator and denominator on the performance measure for NQF #0431 INFLUENZA VACCINATION COVERAGE AMONG HEALTHCARE PERSONNEL. See: 25

26 EP 6 Note Continued: The Joint Commission recommends that organizations use the Centers for Disease Control and Prevention (CDC) and the National Quality Forum (NQF) proposed performance measure to calculate the influenza vaccination rate for staff and licensed independent practitioners. The most researched methodology for calculating the influenza vaccination rate for healthcare personnel available. Clearly delineates numerator and denominator. The CDC reported to The Joint Commission that the measure can be used in all healthcare settings even though it was not tested in all healthcare settings. 26

27 EP 6 Note Continued: The CDC/NQF measure, however, does not include all contracted staff. CDC reported that the data are very difficult to obtain. Inaccurate and unreliable data could inadvertently alter the influenza vaccination rate. Altered influenza vaccination rate could impact some organizations financially in the future because of required reporting. 27

28 EP 6 -The Joint Commission s Position: The influenza vaccination is to be offered to all contracted staff even though not all are to be included in the measurement rate. The Joint Commission recommends that influenza vaccination rates for contracted staff be tracked separately by the organization. The tracked information on contract staff can be used as part of determining improvement for IC EP 8. 28

30 EP 6: Documentation required Scoring: A (exists or does not exist) Implementation: July 1,

31 EP 7: Standard IC The organization collects and reviews the reasons given by staff and licensed independent practitioners for declining the influenza vaccination. This collection and review occurs at least annually. This EP does not require that a declination form be signed. 31

32 EP 7: No documentation required Scoring: A (exists or does not exist) Implementation: July 1,

33 EP 8: The organization improves its vaccination rates according to its established, internal goals at least annually. (For more information, refer to Standards PI and PI ) 33

34 EP 8: Documentation required Scoring: A (exists or does not exist) Implementation: July 1,

36 EP 9: No documentation required Scoring: A (exists or does not exist) Implementation: July 1,

37 Implementation differences by accreditation program: Standard IC For CAH, HAP and LTC: All elements of performance will go into effect in July 1, There is a phased-approach for implementation of Standard IC for other accreditation programs such as AHC and OME. The phased approach for implementation for Standard IC is not applicable to CAH, HAP, and LTC. 37

38 Influenza Vaccination Myths and Realities 38

39 Influenza Vaccination Myths and Realities: Myth 1. The flu vaccine can cause influenza. Reality The injectable flu vaccine does not contain the live virus so it is impossible to get influenza from the vaccine. The nasal spray flu vaccine contains live, attenuated (weakened) viruses that can cause mild signs or symptoms. 2. The flu shot doesn t work. The influenza vaccine will prevent influenza most of the time. In scientific studies, the effectiveness of the vaccine ranges from 70 to 90 percent, depending on how well the circulating viruses match those in the vaccine. 3. Our staff follows Standard Precautions, with good hand hygiene practices and appropriate glove and mask use. Influenza is spread by respiratory droplets generated when talking, coughing or sneezing. Adults shed influenza virus at least one day before any signs or symptoms of the disease. 39

40 Influenza Vaccination Myths and Realities: Myth 4. Our staff stays at home if they are sick - so vaccination is not necessary. 5. There is no evidence to support that influenza vaccination of staff improves patient outcomes. 6. Influenza vaccinations for staff will be too costly. Reality Since unvaccinated individuals are contagious at least one day before any signs or symptoms of influenza appear, they can still shed the virus and infect patients and other staff. Influenza transmission and outbreaks in health care organizations have been recognized for many years and have been associated with substantial morbidity, mortality, and costs. The cost savings associated with health care personnel influenza vaccination programs generally outweigh the costs associated with providing the vaccine, and vaccinating ultimately results in a safer environment for patients. 40

41 Resources: Standard IC Influenza and Influenza Vaccine Myths and Reality An educational document prepared by The Joint Commission Please use during your educational efforts Available with today s hands out. Will also be available on the infection prevention website 41

44 Resources: Joint Commission Resources: The Flu Vaccination Challenge Available at: Purpose: To continue increasing flu vaccination rates among health care workers, since flu vaccination for health care workers is important not only to help protect themselves, but also to reduce the risk of flu infection for patients or the individuals served. Many resources on its website 44

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